动脉内接触性溶栓治疗急性脑梗死时间窗选择与疗效分析

目的 探讨动脉内接触性溶栓治疗急性脑梗死的时间窗选择与疗效的关系.资料与方法 245例脑梗死均在CT检查及血管造影基础上接受选择性动脉内接触性溶栓治疗,其中在发病后6 h以内溶栓者56例,6～24 h溶栓者189例.分析两组患者的血管再通率和90天预后.结果 脑血管造影发现颈内动脉(ICA)系统闭塞173例,椎基底动脉(VBA)系统闭塞72例;溶栓后ICA系统再通113例,VBA系统再通37例.治疗后90天预后好者180例,预后差者65例.溶栓后颅内出血12例.6 h内组和6～24 h组患者血管内溶栓治疗后90天预后良好率分别为80.35 %(45/56)和71.43 %(135/189),血管再通率分别为66.07%(37/56)和59.79%(113/189),血管再通中位时间分别为67 min和73 min.结论 动脉内接触性溶栓可以明显改善脑梗死患者的预后,仅以发病时间不超过6 h作为动脉内溶栓治疗标准不够全面,应当根据病情适当放宽动脉内溶栓的时间窗.     

急性脑梗死溶栓治疗的时间窗及其影响因素分析

目的 分析急性脑梗死患者不同时间的动脉内溶栓治疗效果,探讨影响治疗时间窗的因素.方法 54例脑梗死患者均在CT检查及血管造影基础上接受选择性动脉溶栓治疗其中在6 h以内溶栓者42例,6～24 h溶检者12例.统计两组患者术后血管再通率和神经功能缺失积分差值.结果 两组患者治疗有效率分别为88.1%和75.0%,显效率分别为71.4%和50.0%, 管再通率分别为69.0%和50.0%,血管再通中位时间分别为68和73min.结论 动脉内溶检时间窗是与多种因素密切相关的,仅以发病时间不超过6 h作为治疗标准是不够全面的,应当根据病情合理放宽溶栓的时间窗,最大限度降低患者的病残率,提高了患者的生活质量.     

动脉溶栓与机械碎栓联合动脉溶栓的对比分析

目的 比较两种不同动脉溶栓方法治疗超早期脑梗死患者的疗效,探讨哪种方法更有益于开通血管.方法 收集2009年10月- 2011年5月55例脑梗死急性期并行超早期介入治疗患者,其中25例(联合治疗组)采用机械碎栓联合尿激酶进行动脉内溶栓治疗,30例(尿激酶组)采用尿激酶进行单纯动脉内溶栓治疗.术后观察患者闭塞血管再通和神经功能障碍恢复情况,并比较分析两种动脉溶栓方法的疗效.结果 联合治疗组患者血管再通23例,成功再通率为92%(23/25),尿激酶组患者则为18例,再通成功率仅为60%(18/30).术后平均NIHSS(脑卒中量表)及ADL(日常活动量表)评分联合治疗组(1 h 分别为8.6 ± 2.5和20.0 ± 4.6;24 h分别为9.0 ± 1.8和17.0 ± 2.5)改善程度明显优于尿激酶组(1 h分别为7.5 ± 2.0和28.0 ± 3.5;24 h分别为8.1 ± 2.0和24.0 ± 2.1),两组间差异有统计学意义(P ＜ 0.05).尿激酶用量及溶栓时间联合治疗组分别为(36.8 ± 8.4)万u和(35.3 ± 11.6)min,尿激酶组分别为(50.4 ± 15.3)万u和(55.7 ± 13.3)min,前者低于后者,两组间差异有统计学意义(P ＜ 0.05).结论 超早期应用动脉内机械碎栓联合动脉溶栓治疗急性脑梗死的疗效优于单纯动脉溶栓.     

急性脑梗塞动脉内溶栓治疗时间窗选择与疗效分析

目的探讨急性脑梗塞动脉内溶栓治疗时间及梗塞部位等因素对疗效的影响。方法288例脑梗塞患者均在CT检查及血管造影基础上接受选择性动脉溶栓治疗,其中在6h以内溶栓者76例,6~24h溶栓者212例。统计2组患者的血管再通率和90d后预后情况。结果脑血管造影发现血管闭塞245例,其中颈内动脉系统闭塞173例,椎基底动脉(VBA)闭塞72例;溶栓后再通分别为112例、38例。治疗后90d恢复良好者180例,预后差108例。颅内出血2例。不同治疗时间2组患者治疗后90d预后良好率分别为80.35%和71.43%,血管再通率分别为67.86%和59.26%,血管再通中位时间分别为68min和73min。结论动脉溶栓治疗脑梗塞,动脉内溶栓时间窗与多种因素密切相关。     

应用尿激酶动脉内溶栓治疗急性缺血性脑卒中105例临床观察

目的探讨应用尿激酶动脉内溶栓治疗急性缺血性脑卒中的安全性和有效性。方法对105例急性缺血性脑卒中患者在起病后2～24 h内进行超选择性动脉内尿激酶溶栓,尿激酶用量50～120万单位(平均85万单位)。结果 105例急性缺血性脑卒中中,颈内动脉系统血管闭塞69例,椎-基底动脉系统闭塞19例,脑血管造影未见明显异常17例;经动脉内溶栓治疗后,闭塞的颈内动脉系统再通率为63.8%(44/69),椎-基底动脉系统再通率为63.2%(12/19)。治疗后第7天和第14天神经功能评分分别为:(13.05±8.10)、(8.82±6.00)分,与治疗前的(18.86±8.20)分比较,差异均有统计学意义(t=2.87、2.39,P<0.01);治疗后ADL评分第7天和第14天分别为:(1.75±1.37)、(3.50±1.29)分,与治疗前的(4.82±1.37)分比较,差异均有统计学意义(t=2.52、2.44,P<0.01)。术后随访1年,临床症状完全缓解或明显好转为72.7%(64/88),并发脑出血为3.4%(3/88),消化道出血为11.4%(10/88)。结论应用尿激酶动脉内溶栓治疗急性缺血性脑卒中疗效好、见效快、并发症少。     

rt-PA动脉溶栓治疗急性脑梗死的疗效观察

目的分析动脉溶栓治疗急性脑梗死的安全性及疗效。方法对21例颈内动脉系统梗死患者(颈内动脉3例,大脑中动脉12例,大脑前动脉5例,豆纹动脉1例)进行rt-PA动脉溶栓治疗。治疗时间在发病后2～6h,观察术中血管再通及术后即刻、24h后分别行头颅CT或MRI扫描以明确有无颅内出血。术前及术后30d采用中国脑卒中神经功能缺损程度量表(chinese stroke scale)进行评估。结果21例患者动脉溶栓治疗中技术成功率100%。其中血管再通TMI分级2～3级16例,TMI分级0～1级5例。症状性脑出血3例,其中2例死亡。17例术后30d神经功能缺损评分减少>50%,2例<50%,死亡2例。TMI分级2～3级的血管再通患者生活状态明显优于TMI分级0～1级血管再通患者。结论急性脑梗死6h内动脉溶栓治疗比较合适,但也有并发脑出血的严重后果,开始溶栓时间越早越好。     

急性脑梗死动脉内溶栓治疗疗效观察

目的观察急性脑梗死患者行脑动脉内溶栓治疗的临床疗效。方法26例临床及头颅CT诊断为急性脑梗死患者用尿激酶行经动脉介入溶栓治疗(IATT)，治疗前后均作脑血管造影、复查CT及神经功能缺损评分。结果3例造影未见血管闭塞，23例患者即刻完全再通7例，部分再通11例，再通率78e。结论动脉溶栓疗法使84％的患者在15d内神经功能缺损得到改善，脑动脉内溶栓治疗是治疗急性脑梗死有效的方法之一。     

缺血性脑卒中超早期静脉溶栓治疗

目的 :评价超早期尿激酶静脉溶栓疗法对急性缺血性脑卒中的疗效和安全性。材料和方法 :随机选择 2 0例急性缺血性脑卒中患者 ,发病时间在 6h以内 ,半小时之内静脉滴注尿激酶 15 0× 10 4U/人 ,溶栓前、溶栓后 15min及 2 4h分别做血管造影检查 ,并记录比较患者溶栓前后临床神经功能缺损评分 (欧洲脑卒中评分 )及治疗 90天研究终点时的BarthelIndex和改良RankinScale。结果 :大脑中动脉闭塞 8例 ,6例完全再通 ,1例部分再通 ;大脑前动脉闭塞 1例 ,完全再通 ;颈内动脉闭塞 6例 ,3例部分开通 ,3例未通 ;豆纹动脉闭塞的 5例 ;4例临床完全恢复。本组病例中 2例继发症状性脑出血。有 3例患者死亡 ,死亡率为 15 %。结论 :超早期静脉溶栓可以使闭塞的血管再通 ,改善患者预后 ,但必需严格把握适应证 ,否则会增加脑出血的发病率及患者的死亡率。     

重组葡激酶动静脉途径溶栓治疗犬急性脑梗死对照研究

目的 研究重组葡激酶(r-Sak)经不同途径溶栓治疗犬急性脑栓塞的疗效、并发症及对凝血纤溶系统的影响.方法 成年毕格犬24条,随机分为对照组、r-Sak动脉组、r-Sak静脉组.用介入技术建立犬急性脑栓塞模型,栓塞后5 h(静脉3 h)行脑血管造影观察被栓塞的左颈内动脉通畅情况,继而经成功栓塞的左颈内动脉或股静脉于30 min内注入r-Sak行溶栓治疗(r-Sak组:r-Sak 10 000 u/kg;对照组:生理盐水10 ml).治疗后30、60和120 min分别测定凝血指标并再行脑血管造影观察栓塞血管的再通情况,24 h内对犬作行为学观察,24 h后处死动物行病理检查.结果 溶栓后2 h对照组、r-Sak动脉组和r-Sak静脉组的血管再通率分别为0.0%、93.3%和37.5%,两治疗组与对照组比较差异有统计学意义(P＜0.05);3组完全再通的比率分别为0%、60%和6.7%;血管再通率和完全再通率于动脉组明显高出静脉组(P＜0.05).r-Sak两组对凝血纤溶系统影响的比较无明显差异.24 h内无严重并发症.结论 重组葡激酶具有较强的血栓溶解作用,动脉途径给药比静脉法更能有效溶解脑内血栓.     

急性椎基底动脉闭塞的介入治疗

目的 探讨急性椎基底动脉闭塞动脉内溶栓治疗,溶栓后血管狭窄的处理问题.方法 收集我院2001年1月至2006年7月急性椎基底动脉闭塞患者67例.全脑血管造影后,责任动脉内泵入尿激酶,复查造影,溶栓后动脉残余重度狭窄者置入支架.结果 溶栓后血管完全再通17例(25.4%),血管部分再通41例(61.2%),血管未通9例(13.4%).临床症状恢复良好19例,轻度伤残23例,重度伤残8例,死亡17例.结论 急性椎基底动脉闭塞溶栓治疗是有效的,时间窗应强调个体化,溶栓后血管残余狭窄可行支架置入术.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.